Proven Epstein–Barr encephalitis with negative EBV‐DNA load in cerebrospinal fluid after allogeneic hematopoietic stem cell transplantation in a child with acute lymphoblastic leukemia

We report a case of EBV encephalitis in a seven‐yr‐old child with Ph+ ALL. Two months after an allogeneic HSCT from his HLA mismatched mother, the patient showed an altered sensorium, generalized seizures, and a left hemiparesis. Brain MRI demonstrated multiple lesions highly suggestive for viral en...

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Bibliographic Details
Published in:Pediatric transplantation 2015-02, Vol.19 (1), p.E19-E24
Main Authors: Barberi, Walter, Perrone, Salvatore, Iori, Anna Paola, Torelli, Giovanni Fernando, Testi, Anna Maria, Moleti, Maria Luisa, Ceglie, Teresa, Papoff, Paola, Caresta, Elena, Antonelli, Manila, Gianno, Francesca, Melone, Antonio, Badiali, Manuela, Giangaspero, Felice, Foà, Robin, Gentile, Giuseppe
Format: Article
Language:English
Subjects:
Case Report
Case Reports
cerebrospinal fluid
Child
DNA, Viral - cerebrospinal fluid
encephalitis
Encephalitis, Viral - cerebrospinal fluid
Epstein-Barr virus
Epstein-Barr Virus Infections - cerebrospinal fluid
False Negative Reactions
Hematopoietic Stem Cell Transplantation
Herpesvirus 4, Human - genetics
Humans
leukemia
Male
Postoperative Complications - cerebrospinal fluid
Precursor Cell Lymphoblastic Leukemia-Lymphoma - surgery
Transplantation, Homologous
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Summary:We report a case of EBV encephalitis in a seven‐yr‐old child with Ph+ ALL. Two months after an allogeneic HSCT from his HLA mismatched mother, the patient showed an altered sensorium, generalized seizures, and a left hemiparesis. Brain MRI demonstrated multiple lesions highly suggestive for viral encephalitis. Blood and CSF PCR analyses were negative for the most common viruses involved in immunocompromised patients including EBV. A cerebral biopsy was performed, which showed intense gliosis and perivascular lymphocytic cuffing. PCR analysis performed on brain tissue was positive only for the EBV genome, while extensive investigations for other viral infections were negative. The patient's neurological symptoms rapidly worsened and he died two months later. This case report suggests that in patients presenting neurological and radiological signs of encephalitis after an HSCT, an EBV involvement should be considered, even in the absence of CSF and blood PCR virus detection.
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.12386